**2.1 The burden of suicide**

Suicide is a leading cause of death, particularly among young people. Suicide occurs all over the world in all regions, across cultures, economic and social status and indeed all age groups. Although suicidal behaviors might differ across age groups, sex and geographic regions, no human is immune to it.

Suicide accounts for high rates of deaths in all regions of the world today. According to the WHO [3], statistics reveal close to 800,000 who take their own life every year and this estimated amount differentiates from those who attempt that act alone which sometimes can be more. Suicide is also known to occur throughout the life span with the highest occurrence happening during adolescence. Suicide is the third leading cause of death among 15-19-year-olds. In America, suicide is one of the 10 leading causes of death overall and in persons within the age group of 10–64 years [4]. Every suicide is both an individual tragedy and a part of a public health crisis that imposes a great burden on society [5]. The burden of suicide reaches beyond the deaths themselves, extending to family, friends, and colleagues of the individuals who have died by suicide [6]. According to the Centers for Disease Control and Prevention [7] it is estimated that between six and 32 survivors (e.g. close family and friends) are personally affected by suicide mortality in terms of increased mental health risk, and this may include increased risk of suicide for the bereaved. Concomitantly, suicide results in financial burdens, costing society approximately US\$44.6 billion per year in combined medical and work loss costs [7]. Thus, the prevention of suicide has become a matter of paramount public health importance globally.

## **2.2 Risk factors**

Suicide is preventable as it comes with lots of warning signs that, if detected early enough, can be cured. The more common cause of suicide known to many is depression. Although this majorly leads to suicide, many other factors come to play in explaining the cause of suicide. A combination of social, psychological, environmental, biological, medical and genetic factors could result in suicide. Various studies have been carried out in assessing the risk factors for suicide. Some risk factors associated with suicide are family history of suicide and child maltreatment, family history of alcohol/substance abuse and mental illnesses particularly depression, previous attempts at suicide, impulsive and aggressive behavioral tendencies, feelings of hopelessness, isolation, loss of loved ones, job or financial difficulties, physical illness, lack of access to mental health care, abuse, local epidemics of suicide, stigma and other factors that hinders one from seeking help [8].

In a study [9] on suicide trajectories, it was revealed that although mental illnesses as depression and anxiety result in Suicidal Behaviors across the lifespan, past and present studies have revealed that other factors as impulsive aggression, conduct disorder, interpersonal conflict, antisocial behavior, and alcohol and

substance abuse more prominently result in suicidal behaviors among adolescents and young adults.

#### **2.3 Suicide related behavior**

The suicide-related behaviors to always look out for are:


Although suicide is commonplace globally, there is still an existing stigma associated with this act and with any form of mental illness in some parts of the world today. This often prevents those who are at risk from speaking up and from seeking help. A study [10] revealed that although there has been a reduction in the stigmatization of mental illnesses, suicide remains as stigmatized as ever. Many developing countries of the world today, including Nigeria, do not have meaningful statistical records of suicide and suicide-related behaviors. Because there is no proper record of deaths and their causes in most developing countries, it can be said that suicide rates are grossly underreported globally.

#### **3. Social media and mental health**

The relationship between social media and mental health is extant as social media are being linked to mental health problems like stress, psychological distress, anxiety and depression. In recent times, there is a rising research interest on this topic as research works carried out have established a link between mental health, lifestyle and social media. Social media have been linked to high rates of depression, anxiety and poor sleep, and research has revealed a 70% increase in depression and anxiety resulting from social media use in the past 25 years [11]. Other literatures have also described social media as being more addictive than substances like alcohol and cigarette [11]. There are now such terms as 'Facebook depression' which occurs as a result of spending so much time on Facebook and being exposed

to the intensity of online activities of others that one starts to exhibit depressive symptoms. FOMO—Fear of Missing Out is another issue of mental health concern that results from the constant use of social media. It is a form of anxiety aroused by the fear that others might be having exciting and rewarding experiences from which one is missing out on. It results in the constant desire to be everywhere events are taking place, the constant need to check one's phone for the latest updates, the obsessive desire to always stay connected with what others are doing [12]. FOMO often affects both mental and physical health, and it results in the feeling of inferiority, life dissatisfaction, mood swings, low self-esteem, loneliness, increased negative feelings and depression [12].

Social media also encourage attitudes that are unhealthy to mental health such as unhealthy comparisons, jealousy, emulations, and counterfeit appearances. Most people put up only the best version of their lives on social media and with this might torture others who follow them and aspire to be like them. It has encouraged the living of fake lives just for social media presence.

The change in lifestyle that results from social media use has become an issue of concern globally due to the rising rate of mental health disorders. It has become important for people to learn proper ways of using social media to their benefit and not otherwise.

#### **3.1 Social media exposure: risks and safety**

Social media and its effect on suicide related behavior have now become a topic of growing concern and debate [13]. The question that results is if social media help in suicide prevention or helps in increasing suicidal behaviors. Social media and the internet, in general, have helped in the advancement of communication, social connections, and businesses, which have helped make man's life better. This being the case, in promoting suicide prevention, social media come in handy as a powerful tool, as this same platform is now evidently being associated with enhancing suicidal behaviors especially among teenagers. The risk of social media usage today is now more associated with adolescents simply because they are the more vulnerable population who are likely to be influenced. The adolescent stage is a stage of significant developmental changes where there is an increased risk of experimentation and peer emulation, teens at this stage are trying to form an identity that leads them to be more susceptible to peer pressures. With adolescence comes the tendency to engage in risky behaviors which also explains why there is a high rate of social media misuse among adolescents.

There is no doubt that adolescents have a lot to benefit from the use of social media both socially, academically and personally. It helps in enhancing communication skills and connecting with others. They can experiment with self-expression, share ideas and learn from others. It also helps in developing new interests and skills as there are basic social and technical skills important to everyday functioning that are learnt through social media use [14]. Most adolescents utilize social media as an extension of activities and relationships that take place at school; with social media, they can build on their social skills and enrich their friendships [14]. With this, it can be said that teen deprivation of social media could take its toll on their social skills and learning experiences.

Social media also serve as a useful tool to reach people in crises by providing information, guidance, and support. In present times, the internet has been employed as a tool of intervention for those facing several types of mental difficulties. With social media, online resources/information, counseling/therapy, and support groups can be easily accessed. On the downside, there is the risk of accessing vulgar, distressing and negative information that affects more vulnerable people. There are now series of contents that not only encourage risky behaviors like substance abuse, casual sex, sexting, pornography, inappropriate sexual behaviors, and suicide but also go out to attack or bully others into these behaviors.

#### **4. Suicide risk factors associated with social media usage**

#### **4.1 Cyberbullying**

This is also referred to as cyber-harassment or online bullying. It is a form of bullying or harassment that takes place online using electronic devices like mobile phones and computers and social media are the main platform often used in carrying out this act. In cyberbullying, the perpetrator harasses the victim by putting out negative, harmful and false posts, comments and contents about the victim [15]. It could also involve the perpetrator sending out private information about the victim to embarrass or humiliate the other party [15]. An eminent example is an act of cyberbullying that led to the death of a college student in 2010 called Tyler Clementi who committed suicide after a fellow student posted her private sexual encounter with another male student on social media [16]. Cyberbullicide is suicide which results from cyberbullying. Cyberbullying has led to suicide and suicidal behaviors among adolescents. Victims of cyberbullying are at a higher risk of experiencing self-harm and suicidal behaviors than those who are not [17]. Teenagers who experience any form of bullying including cyberbullying are at a higher risk of anxiety, sleep deprivation, poor academic performance, dropping out of school and depression [18]. It has been recorded that Seven in ten young people have experienced cyberbullying, with 37% of them saying they experience cyberbullying on a high-frequency basis [11]. Research [19] also revealed that students who experience any form of bullying and cyberbullying are twice more likely to attempt suicide. In a study [20], 33.8% of students reported that they have been cyberbullied in their lifetime while 11.5% admitted to having cyberbullied others.

#### **4.2 Body image dissatisfaction**

This can be defined as the feelings and negative attitudes a person has about their body and is usually influenced by certain factors such as the cultural norms relating to an ideal body, personal perceptions toward weight gain, and body appearance [21]. In a study [22] social media were revealed to influence the attitude of young women and adolescent girls causing them to engage in social comparisons which often leads to the feeling of inadequacy and body dissatisfaction. Concerns with body image lead people to depression and suicidal thoughts. Body image dissatisfaction occurs in both male and female although it tends to be more common in females, both genders are exposed to images online which they tend to fix as their perfect and ideal body. The activities and images portrayed by celebrities and social media influencers play a huge role in shaping standards for young people as they strive to emulate their admirers online.

Body image dissatisfaction often results in feelings of low self-esteem, depression, low body confidence, eating disorders. Results from a study revealed a link between suicide ideation and how both male and female adolescents perceive their body image [23].

#### **4.3 Substance abuse**

The link between social media use and substance abuse cannot be overlooked as social media are not only capable of pressuring one to use substances but also

#### *Social Media and Suicide DOI: http://dx.doi.org/10.5772/intechopen.92160*

provide a platform that eases the process of accessing hard drugs. Drug dealers now use social media to connect with their buyers all over the world which makes it easy to purchase hard drugs online. Adolescents through social media are being constantly exposed to the popularity of drug use, it has become commonplace to see celebrities display their use of hard drugs online [24]. The behavior of celebrities and social media influencers who glamorize and normalize the abuse of substances on social media goes a long way in influencing the attitude of adolescents who follow them [24]. Most adolescent engages in comparison with such social media influencers and by these, they begin to lose their values as they seek to emulate the popular behaviors they perceive online. Such social comparison could lead to depressive symptoms and other mental health difficulties which could in turn fuel the abuse of substances. The view that friends and fans on social media are having fun with their lifestyle can tempt adolescents into risky behaviors just to fit in. All these experiences are detrimental to mental health and can increase suicide risk.

#### **4.4 Suicide contagion**

This is a possible increase in suicide or suicide-related behaviors that results from exposure to information on suicide-related behaviors and actual suicide occurrences within one's immediate group. This form of information is often passed across through social media and can become popular within a very short time. The term 'Werther effect' explains a case of suicide that occurs as a result of a person copying cases of suicidal behaviors seen or heard of from various online platforms. Werther effect also referred to as copycat suicide and it explains the process of suicide contagion [16]. A person who has prior suicidal thoughts but is unable to carry out the act for several contingent issues of concern can suddenly become motivated to carry out the act after learning of another's case of suicide on media. The term 'Werther' was derived from a book written by Johann Wolfgang von Goethe titled 'The Sorrows of Young Werther', in which the principal character in the book named Werther, ends his own life by shooting himself at his desk [25]. After the book was published, several suicide cases were recorded with similar methods to the suicide case described in the book. This made it evident that the suicide cases that followed were influenced by that of Werther's character in the novel. Reporting of suicide cases especially celebrity suicide has popularized the incidence of suicide among the general public and it has now become very crucial that guidelines be adhered to, to reduce the popularity of suicide through Werther Effect.
